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Aim: This study aimed to explore dietitians' perceptions of their current practice for identifying and managing malnutrition/frailty in the community, to fill an evidence gap. Methods: This mixed‐methods study involved an online survey distributed to dietitians practising in Australia and New Zealand, and semi‐structured interviews with a subset of survey participants. The 34‐item survey and interviews explored dietitians' practices for identifying/managing malnutrition and frailty, focusing on the community setting. Survey data were analysed descriptively and some simple association tests were conducted using statistical software. Interview data were analysed thematically. Results: Of the 186 survey respondents, 18 also participated in an interview. Screening and assessment for malnutrition varied in the community and occurred rarely for frailty. Dietitians reported practising person‐centred care by involving clients/carers/family in setting goals and selecting nutrition interventions. Key barriers to providing nutrition care to community‐dwelling adults included a lack of awareness/understanding of nutrition by clients and other health professionals (leading to them not participating in or valuing nutrition care), lack of time and resources in the community, and client access to foods/supplements. Enablers included engaging family members/carers and coordinating with other health professionals in nutrition care planning. Conclusion: Reported practices for identifying malnutrition and frailty vary in the community, suggesting guidance may be needed for health professionals in this setting. Dietitians reported using person‐centred care with malnourished and frail clients but encountered barriers in community settings. Engaging family members/carers and multidisciplinary colleagues may help overcome some of these barriers. [ABSTRACT FROM AUTHOR]

Aim: Adults living with severe mental illness experience a greater burden of physical comorbidities and earlier mortality than the general population. Malnutrition, overnutrition, dysphagia, constipation and disordered eating have been observed in this population and can lead to poor nutritional status. Early identification of such conditions may reduce their impact on functional status, quality of life and health outcomes. This scoping review aimed to identify all nutrition risk screening methods published in English internationally for use with adults living with severe mental illness and ascertain which, if any, were validated for the target population. Methods: A four‐step search strategy was used to search six electronic databases and grey literature, from inception to April 2020, for articles reporting nutrition risk screening methods used in this population. Information on the content and validity of screening methods was extracted and analysed by three independent reviewers. Results: Seventeen nutrition risk screening methods were identified, of which three were validated within a population of adults with severe mental illness. One screening method was found for both malnutrition and dysphagia risk, respectively, and three for constipation risk. No single method was found for overnutrition. Eleven screening methods were identified for disordered eating risk, of which two were validated for the target population. Conclusions: Nutrition risk screening methods and their validation in adults living with severe mental illness are inadequately researched. This scoping review highlights the need for future research to develop new or validate existing screening methods specifically for the target population. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to identify variables associated with sarcopenia in cirrhotic outpatients using clinical data, anthropometric measures and lab tests. In a single centre prospective study, 261 cirrhotic outpatients were followed on average for 2 years. The diagnostic criteria of sarcopenia were applied according to the current guidelines, combining muscle strength and appendicular muscle mass index. Methods: Age, sex, liver disease aetiology and the Model of End‐Stage Liver Disease score were included as independent variables, as well as mid‐arm circumference (MAC), body mass index and triceps skinfold. Multiple logistic regression was applied including all independent variables (maximum model). Then, the analysis was performed only with the variables that were significant in the first analysis (parsimonious model). Once the variable most related to sarcopenia was determined by the two models, the area under the receiver operator characteristic curve was calculated. Mortality rates were described for patients with and without sarcopenia. Results: Sarcopenia was diagnosed in 14 subjects (5.36%), and the variable best associated with sarcopenia was MAC (P < 0.01). The 1‐year mortality rate of 35.71% found among subjects with sarcopenia was not significantly higher (P = 0.07) than the 15.38% observed among those without this condition. Conclusions: Before examinations requiring ionising radiation, patients with cirrhosis can be submitted to simple screening tools to identify those who have a high risk of sarcopenia, thus promoting a cost‐effective assessment. [ABSTRACT FROM AUTHOR]

Aim: Malnutrition is highly prevalent in rehabilitation patients, and screening is important to allow for timely intervention to reduce the incidence of adverse clinical outcomes. We aimed to determine the reliability and validity of the commonly employed malnutrition screening tool by non‐dietitian staff in categorising patients at risk of malnutrition in the rehabilitation setting. Methods: This prospective observational cohort study recruited 100 participants on admission to a rehabilitation ward. The malnutrition screening tool was applied by nursing staff and repeated by nutrition assistants. Results were compared to malnutrition as determined by dietitian‐applied subjective global assessment of each patient. Inter‐rater reliability tests were conducted with two dietitians, two nutrition assistants and two nurses independently but simultaneously recording malnutrition screening tool scores on a subgroup of 15 participants. Results: Agreement between dietitian‐determined malnutrition and risk as identified by nutrition assistant and nursing staff screening tool application was only modest (64% and 51%, respectively). While both professions met the a priori criteria for acceptable specificity (≥60%), neither met the criterion for adequate sensitivity (≥80%). The inter‐rater reliability of the tool was excellent, with almost perfect agreement (≥0.89) between ward dietitian and nutrition assistants, and moderate to substantial agreement (0.56–0.65) with nursing staff, when compared to a senior dietitian. Conclusions: Non‐dietitian staff failed to apply the malnutrition screening tool with sufficient sensitivity in normal ward practice to warrant its use in the rehabilitation setting. Alternative options for identification of malnutrition need to be considered to ensure appropriate treatment. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to determine if the Malnutrition Screening Tool (MST) is valid for use within the Community Rehabilitation Program (CRP) setting. Secondary outcome measures were to assess malnutrition prevalence in the CRP population and to determine trends between malnutrition and age, body mass index (BMI) and falls history. Methods: This study used a cross‐sectional design. All clients admitted to a Melbourne metropolitan CRP during the study period had the MST completed at intake. A total of 160 participants were then selected at random and a Subjective Global Assessment (SGA) was completed by an experienced dietitian. Participants were classified as well nourished or malnourished, and this result was compared to their MST score. Data analysis was completed to determine the predictive value of the MST compared to SGA, which was expressed using sensitivity, specificity, positive and negative predictive values. Results: Out of the 160 participants, 34.0% were identified as malnourished. The MST achieved a sensitivity of 72.2% and a specificity of 83.8% with positive predictive value of 69.6% and negative predictive value of 85.4% compared to the SGA. Participants in the malnourished group were older and had a lower BMI (P < 0.05). Conclusions: Considering the demographics and needs of the CRP population group and the predictive value of the MST compared to SGA, it can be concluded that the MST is a valid screening tool for use in this population and has relatively low burden to complete. Consequently, the MST could be included in the client initial needs identification to be completed when admitted to the program. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to assess the test–retest reliability, relative validity and responsiveness to change of a 20‐item fat and fibre behaviour questionnaire (FFBQ) compared with a semi‐quantitative food frequency questionnaire (FFQ). Methods: Four hundred thirty‐four primary care patients with type 2 diabetes and/or hypertension were randomised to lifestyle intervention or usual care. Data (FFBQ and FFQ) were collected at baseline and 4 months follow‐up. A subset of usual care participants (n = 27) completed the FFBQ 2 weeks after baseline. FFQ‐measured nutrients included total and saturated fat (percentage of energy; energy‐adjusted grams) and fibre (crude grams; energy‐adjusted grams). The FFBQ was scored as a total, fat and fibre index. Test–retest reliability was assessed by intra‐class correlations (ICCs); relative validity by Pearson's correlations between the FFBQ and FFQ; and responsiveness (mean change in intervention group divided by SD of usual care group change). Results: Test–retest ICCs (95% CI) were 0.87 (0.62, 0.95) for total index, 0.87 (0.69, 0.95) for fat index and 0.89 (0.69, 0.95) for fibre index. Pearson's correlations for fat index ranged from −0.50 to −0.54, and for fibre index from 0.42 to 0.56. Total index had correlations of 0.5–0.6 (or −0.5 to −0.6) with all FFQ‐measured nutrients except crude fibre. The fat index showed similar responsiveness compared with FFQ‐measured fat intake while the fibre index was significantly more responsive than FFQ‐measured fibre. Conclusions: The FFBQ may provide a suitable alternative or adjunct to FFQs for use in intervention trials in adults with chronic diseases, because of its ability to detect changes in dietary behaviours. [ABSTRACT FROM AUTHOR]

Aims This study aimed to determine if nutritional status as assessed by the revised Mini Nutritional Assessment- Short Form is predictive of relevant clinical outcomes within six months in older rehabilitation patients, and to investigate the relationship between admission diagnosis and nutritional status. Methods A consecutive retrospective case note audit of 181 patients ≥ 65 years admitted to rehabilitation between May and November 2010 at the Repatriation General Hospital was performed. Nutritional status was assessed using the revised Mini Nutritional Assessment- Short Form. Outcomes measured included length of stay in rehabilitation, complications during admission, participation in rehabilitation activities and change in function during admission. Acute readmissions and mortality were assessed at six months post discharge from rehabilitation. Results Thirty-nine (22%) patients had normal nutritional status, 98 (54%) were at risk of malnutrition and 43 (24%) were malnourished. Patients at risk of malnutrition/malnourished had a longer length of stay ( P = 0.008) and were more likely to be poor participators in rehabilitation activities ( P = 0.006). Malnourished patients had poor function on admission to rehabilitation ( P < 0.001) and had the greatest improvement in function during the rehabilitation admission ( P = 0.012). Conclusions Over three-quarters of older rehabilitation patients were identified as malnourished or at risk of malnutrition, and this was associated with poorer function on admission, increased length of stay and poorer participation in rehabilitation activities. Thus, the issue of malnutrition is a concern as it impacts on clinical outcomes of rehabilitation and therefore, further investigation and attention to nutritional status during admission is required. [ABSTRACT FROM AUTHOR]

Aim: To determine the extent of malnutrition and malnutrition risk among community-living older people (aged 65 years and over) who are receiving care from a metropolitan home nursing service in Victoria, Australia. Method: Over a 3-month period (May-July 2009), 235 clients aged 65 years and over from a community nursing service providing home nursing care were assessed for malnutrition using the Mini Nutritional Assessment (MNA®, Nestle, Vevey, Switzerland). Results: Thirty-four per cent (34.5%) of clients were identified as being at risk of malnutrition, while 8.1% were found to be malnourished. There was no significant relationship between nutrition risk and gender, country of birth or living arrangements. Conclusion: Malnutrition and nutrition risk was found to be an issue among this sample of community-living older adults who were receiving home nursing care in Victoria, Australia. In this study, just over 40% of the participants were either at risk of malnutrition or malnourished, which highlights the vulnerability of this group of older people and the need for routine nutrition screening and a targeted intervention program to address nutrition issues. [ABSTRACT FROM AUTHOR]

Aim: To investigate the perspectives of older, single-living New Zealand men towards healthy eating. Methods: Twelve semistructured interviews with men aged 75 to 89 years using mixed methods and a general inductive analysis approach. To enrich description, participants were assessed for nutrition risk using a validated questionnaire, Seniors in the Community: Risk Evaluation for Eating and Nutrition, and nutrition knowledge using the General Nutrition Knowledge Questionnaire. Results: Six of the men were assessed to be at high nutrition risk. Eating alone was the most common nutrition risk factor. The mean score for the nutrition knowledge questionnaire was 58.3 ± 12.7 out of maximum score of 110. Three core themes related to healthy eating practices emerged from the analysis. Firstly, the men were influenced by their individual circumstances. Limited finances and a lack of personal transport were barriers to healthy eating and were partially ameliorated by reliable, support networks. Secondly, a lack of nutrition knowledge and cooking skills impinged on both healthy eating and meal enjoyment. Thirdly, food-related values held by the men impacted eating behaviours positively or negatively. Conclusion: The present study provides an insight into the perspectives of older men towards their food-related activities. Past experiences shaped their approach towards healthy eating. Community programmes need to identify those at nutrition risk, provide those at need with knowledge and skills and promote meal sharing. Initiatives need to be cognisant of the food-related values, desire for time and effort efficiency and the explicit needs and wishes of older men. [ABSTRACT FROM AUTHOR]

The present study aimed to test the validity, reliability and sensitivity of a two-question depression screening instrument with the Center for Epidemiologic Studies Depression Scale in human immunodeficiency virus-infected subjects. The present study is a self-administered questionnaire of the two-question depression screening instrument and the Center for Epidemiologic Studies Depression Scale-D10 completed contemporaneously by participants to assess the validity, reliability and sensitivity of the instrument. Eighty participants (76 men and 4 women) with a mean age of 43.4 years were enrolled to the study. In this cohort the prevalence of depression was found to be 36%. A significant correlation ( rho= 0.68, P < 0.0001) was found between the depression screening instrument and Center for Epidemiologic Studies Depression Scale indicating adequate validity. The internal reliability of the depression screening instrument was found to be 0.77. The two-question instrument yielded a sensitivity of 89.7% and a specificity of 58.8%. The false positive rate was 41.2%. However, the false negative rate in this population was found to be only 10.3%. The negative predictive value was 90.9%. The results of the present study indicated that the two-question depression screening instrument was valid, reliable and sensitive for detecting individuals at risk of depression in a cohort of people living with human immunodeficiency virus attending a nutrition clinic in an enhanced care setting. [ABSTRACT FROM AUTHOR]

Nutrition screening can identify patients at risk for malnutrition so that early nutrition intervention can be initiated. The aim of this descriptive study was to compare nutrition screening practices in Australian hospitals in 2008 with those in 1995. A survey on nutrition screening practices in Australian healthcare institutions was sent to members of the Dietitians Association of Australia in 1995 and a similar survey in 2008. Sixty-eight hospitals responded to the 2008 survey and 124 hospitals to the 1995 survey. The number of hospitals reporting the conduct of nutrition screening has increased since 1995 (78% vs 23%). The number of patients being screened has also increased (all admissions 54% vs 35%) and the time taken to screen a patient has decreased (0-5 minutes 64% vs 13%). The Malnutrition Screening Tool was the most frequently reported screening tool used in 2008 (67%). The use of albumin as a nutrition screening parameter (which was the second most commonly used screening indicator after weight loss in 1995) has appropriately decreased (9% vs 65%). There is still some confusion among dietitians as to the definition of screening, with nutrition assessment tools such as Subjective Global Assessment and Mini-Nutritional Assessment being used during the nutrition screening process (16% in 2008). Insufficient time and staff are still the top two barriers to nutrition screening implementation. Staff training was the most frequently cited strategy to assist with successful implementation of nutrition screening. There has been a significant increase in malnutrition screening over the past decade despite ongoing barriers to implementation. [ABSTRACT FROM AUTHOR]

Aim: To identify the prevalence of nutrition risk among community-living older people in Christchurch, New Zealand and to establish the frequently occurring risk factors for poor nutrition. Methods: A convenience sample of 152 community-living older people was recruited from five medical centres and a falls prevention service. Interview in the home included nutrition risk assessment as measured by the Seniors in the Community: Risk Evaluation for Eating and Nutrition questionnaire. All participants at nutrition risk were either provided dietary advice at the time of interview or offered referral to a nutrition-related intervention. Results: Of the participants, 23% (n = 35) were ‘at risk’ of poor nutrition and 31% (n = 47) were ‘at high risk’. The four frequently occurring risk factors for those ‘at high risk’ were: unintentional weight change (79%), eating alone (72%), perception of own weight (68%) and low milk product intake (66%). Conclusion: Seniors in the Community: Risk Evaluation for Eating and Nutrition questionnaire identified that approximately half of a sample of community-living older people in Christchurch were at risk of poor nutrition. The implications of low scores on the nutrition risk screening questionnaire deserve further exploration. [ABSTRACT FROM AUTHOR]

Aim: To determine patient satisfaction with nutrition interventions in outpatients receiving chemotherapy identified as at nutritional risk. Methods: An observational, cross-sectional study was conducted at an Australian public hospital in 61 oncology outpatients receiving chemotherapy. A simple malnutrition screening tool was used to identify nutritional risk. Patients identified as moderate risk were triaged to receive nutrition handouts on increasing energy and protein intake. Those at high risk received nutrition counselling and support by a dietitian. Patient satisfaction was assessed using a modification of a valid and reliable satisfaction with nutrition services questionnaire. Results: Sixty-one patients entered the study and one-third (20/61) were at nutritional risk. Seven patients were at high risk, and received dietetic review while 13 patients were at moderate risk and received nutrition handouts. Patients identified as at nutritional risk (n = 20) were approached to complete the satisfaction with nutrition services questionnaire. Eighteen patients completed the questionnaire (n = 7: dietetic review; and n = 11: nutrition handout). Nutrition information/advice was rated as helpful (n = 15), met patient expectations (n = 16) and overall patient satisfaction was rated highly. Patients who had received a dietitian review recorded a clinically but not statistically higher overall satisfaction with nutrition services than those patients receiving the nutrition handout. Conclusion: The high patient satisfaction helps support nutrition intervention at the chemotherapy unit. A prospective trial is required to determine the benefits of this triage and nutrition intervention on nutrition-related outcomes. [ABSTRACT FROM AUTHOR]